Moderation, mediation, and moderated mediation.

Abstract

World Psychiatry 18:3 October 2019 Similarly, processes of change supposedly need to be treatment program specific. This idea emerges from a protocol focus – defending that a method engages unique processes of change – but it takes on a different hue when treatment is processbased. If processes of change are central, why is it lethal if various technologies alter them? Treatment generality might in principle make change processes more important, not less. Processes of change ultimately must be theory based and testable, but techniques under various banners and brand names may alter overlapping and broadly applicable processes of change. From the practitioners’ point of view, so much the better. That fact empowers prac titioners to broaden the range of methods they use in order to target an important change process. Longitudinal evidence, basic research evidence, and component study evidence suggest that some processes of change are more important than others. For example, it would be strange if processes of change had no linkage to variation, selection, retention, and context sensitivity processes that are to be key to the evolution of complex systems in every other area of life. Indeed, it is worth noting that some of the patient-supplied outcomes described by Cuijpers – such as interpersonal effectiveness, social support, the capacity for problem solving, accepting and valuing oneself, awareness, or self-understand ing – have been examined in other con texts under the rubric of processes of change. This suggests that patients themselves intuitively care about processes of change even when traditional intervention science has not focused effectively on them. Departing from a nomothetic latent disease model and embracing the idiographic complexity of human suffering could free the field to pursue a more processbased approach. Focusing on therapeutic change processes should not be a side note but should take center-stage if we want clinical science to move forward.